Area Hospital Admissions Are Fewer, Stays Are Shorter

At North Penn Hospital, the short-term surgery unit is now open until 9 p.m. each weekday instead of closing at 5 p.m.

At Quakertown Community Hospital, cooperation between the medical staff and the administration has increased dramatically.

Only at Grand View Hospital, among the three hospitals, has little changed.

The three hospitals, each in its own way, are reacting to changes in federal Medicare and state Medicaid programs that affect the way they do business.

Since July 1, the two medical insurance programs have paid hospitals according to schedules known as diagnosis related groups, or DRGs.

This effort by government to control ballooning health costs rewards hospitals that discharge patients sooner or perform services, such as minor surgery, on an out-patient basis.

As a result, most patients are spending fewer days in hospitals, and hospital occupancy rates are declining, accelerating a trend that began several years ago, said Jane Snyder, vice president of public relations for the Delaware Valley Hospital Council.

At Quakertown Community, for instance, the average length of stay has fallen from 8.5 days in fiscal year 1982 to a projected 7.5 days this fiscal year.

The introduction of DRGs has also accelerated a national trend toward fewer hospital admissions in recent years.

At North Penn, for example, admissions are expected to drop to 6,137 this fiscal year, compared with 7,146 during fiscal year 1983.

Only ambitious buildings programs and increases in beds at Grand View and Quakertown Community have permitted those hospitals to buck the trend toward fewer admissions.

Admissions at Grand View are expected to reach 9,350 this fiscal year, about 1,300 more than in fiscal year 1982. At Quakertown Community, the increase has not been as dramatic, rising from 2,844 admissions in fiscal year 1982 to an expected 3,100 this fiscal year.

"I guess the biggest thing I can see is that it has accelerated a trend that has been going on for the last nine or 10 years, and that is moving people from an in-patient setting to an out-patient setting," North Penn President Robert McKay said.

The DRG payment system has pushed what had been a gradual trend. For example, it requires cataract and dilate and curettage surgeries to be done only on an out-patient basis. "It's almost a mandated situation," McKay said.

Today, out-patient surgery accounts for almost 50 percent of the 4,000 surgical procedures performed yearly at the hospital.

That is an increase of 12 percent compared with last fiscal year. Ten years ago it was unheard of for patients undergoing surgery at the hospital to leave the same day, McKay said.

As a result, the hospital has lengthened the hours of its short-procedure unit, an ambulatory surgery service. Instead of closing at 5 p.m. each weekday, the unit is open until 9 p.m.

"If we closed at 5 o'clock, we couldn't do a procedure at 12 o'clock and reasonably expect a patient to be ready to go home at 5 o'clock," he said.

At Quakertown Community, DRGs have contributed to the shortening of the average length of stay by one day during the the past two years, Chief of Operations Brad Barry said.

But the biggest change they have wrought is an increase in cooperation.

"I would say the largest effect has been the increase in cooperation between the hospital administration and medical staff and (in) the awareness of each other's problems and needs," Barry said.

The medical staff has a more flexible schedule to fit the pattern of decreasing admissions and shorter stays. During the first three months of the year, for instance, there is usually an increase in orthopedic cases because of skiing accidents and falls on ice, Barry said.

Barry said DRGs have also required the hospital to increase measures to ensure that the quality of care is not any less during shorter stays and to revamp data processing to permit the medical staff to get information more frequently.

At Grand View Hospital, spokesman Scotty Campbell said the hospital was the first in the area to provide short-stay surgery and a variety of in-home and out-patient health services.